Need Help w/ Lab Results: Normal TSH, low FT3, low-normal FT4

[KatieDid1988]

Hi all,

I'd be very grateful if someone could give me some advice. I'm a 26 year old female. For the past 2+ years my symptoms have been:

-body temp is consistently 96 degrees
-extreme fatigue, I often feel like I’m in a fog or daze, almost disconnected from the real world
-trouble going to sleep at night, wake several times throughout the night, wake feeling tired
-Raynaud’s: cold hands and feet, especially feet. They go numb and turn white if even slightly cold, then turn red/purple
-edema, swelling in right foot, calves
-Chronic constipation, bloating, digestive distress
-Chronic sprain/tendonitis in foot/ankle that won't heal going on 2 years
-high cholesterol of 230 despite great diet
-extreme difficultly losing weight
-irregular, heavy periods. I’ll go 2-6 months without a period. Flow is heavy, clots.
-anxiety and panic attacks
-chronic low-grade depression. Then every 3-4 days, I’ll wake up severely depressed. I’ll not want to talk to anyone or even look people in the eye. Feel like I don’t want to be alive and very hopeless.
-severe mood swings, content one day, angry, hostile the next
-thinning of eyebrows,
-brittle, ridged nails
-heavy feeling in legs like I'm dragging through mud
-loss of interest in activities and life in general; I don’t want to talk to anyone or see my friends

I recently got thyroid and other blood work done and my results were:

TSH: 2.0 (range 0.55-4.78)
FT4: 1.0 (range: 0.89-1.76)
FT3: 2.1 (range 2.3-4.2)
Reverse T3: 11.4 (range 7.5.19)
No antibodies

High sensitivity CRP: 0.2 (puts me in the low risk range for future MI or Stroke)
ANA: Negative

Since I have hypo symptoms, low FT3, low-normal FT4, and a normal TSH, I believe I have central hypothyroidism, caused by a dysfunctional hypothalamic-pituitary system.

As I understand it, the hypothalamus-pituitary system can be dysfunctional due to genetic alterations, toxins, drugs, stress, aging. I also researched that it can be caused by tumors on the pituitary, vascular disease, traumatic brain injury, infections.

Other info: I had a bad car accident 2 years ago, but my MRI was clear. I had a brain and cervical spine MRI last year, which came back clear (would a pituitary tumor show up on those?). I binge drank 1-2 times per week from 2007-2013 and did recreational drugs from 2011-2013 include ecstasy (about 20 times) and cocaine (about 6 times). I do not drink or do drugs anymore. I have Raynaud's Syndrome. I have a high lipoprotein A (136 with the range being <30), which indicates a higher risk for eventually developing cardiovascular disease. My triglycerides, however, are in normal range.

My big question is: How do you determine what the underlying cause of the hypothalamic-pituitary dysfunction is? Should I treat the underlying cause, or is supplementing with natural desiccated thyroid hormone sufficient? I don't doubt that NDT would remedy my symptoms, but I would also like to determine what is causing the dysfunction. Is it dangerous to jump straight to treating with NDT, without figuring out what caused this state in the first place? Or is it best to treat with NDT, while trying to figure out the underlying cause? If the dysfunction is due to stress or something non-threatening, is it possible to get the hypothalamus-pituitary system back to normal without NDT?

Based on my low CRP result, it seems that I have no inflammation in my body, so would that rule out any chronic illness or infection?

Thanks!

Katie

[Red_Star]

My sister had her labs done and her TSH was 0.4 mU/L with free T4 of 12 pmol/L (10 - 20). She has Hashimoto's thyroiditis causing her hypothyroid symptoms so I knew she didn't have central hypothyroidism.  I found out later she had dengue fever during those tests and infection can affect TSH results. If you do actually have central hypothyroidism, the most common cause is a pituitary tumour.

"Hypothalamic-pituitary tumors can cause central hypothyroidism by compression of the hypothalamus or pituitary, which results in a decrease in TRH or TSH secretion, or by disrupting signalling between the hypothalamus and pituitary. Other causes of central hypothyroidism include lymphocytic hypophysitis, Sheehan syndrome, traumatic brain injury, subarachnoid hemorrhage, and infiltrative disorders. Patients with central hypothyroidism frequently have other pituitary hormone deficiencies." - Up-To-Date - Central hypothyroidism

[Barb135]

Which antibody tests did you have done?  Have you had a thyroid ultrasound to determine if you have nodules on your thyroid?

[KatieDid1988]

Thanks for the response Red_Star. All of my other test results have come back normal so I don't believe I have any chronic illness. It could be a pit tumor, but I had an MRI of my brain and cervical spine done last year and nothing was found...however, they weren't looking for a pit tumor at the time. I wonder if it's possible it would be overlooked if they weren't looking for it?

[KatieDid1988]

Hi Barb, I had Thyroid Peroxidase Antibody (TPOAb), which came back <10 with a range of <35 and Thyroglobulin Antibody (TgAb), which came back <20 with a range of <40. I have not had an ultrasound. My doctor has only felt my thyroid and said that she didn't feel any nodules.

[Barb135]

You can't go by feel alone... my pcp swore that I had neither nodules, nor goiter, but my ENT sent me for an ultra sound and it turned out that I had both... the nodules were on the back side of my thyroid where they could not be felt via palpation.  An ultra sound is necessary!!